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Farhangee A, Davies MJ, Mesina M, Morgan DR, Sieniewicz BJ, Meyrick R, Gaughan K, Mîndrilă I. Comparative Analysis of Response to Cardiac Resynchronisation Therapy Upgrades in Patients with Implantable Cardioverter-Defibrillators and Pacemakers. J Clin Med 2024; 13:2755. [PMID: 38792297 PMCID: PMC11122322 DOI: 10.3390/jcm13102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction: The efficacy of de novo cardiac resynchronisation therapy (CRT) in patients with heart failure (HF), left ventricular systolic dysfunction (LVSD), and a broad QRS morphology is well established. However, the optimal stage for upgrading patients with existing pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) and HF with high-burden right ventricular (RV) pacing remains uncertain. Thus, this multicentre retrospective analysis compared patients with pre-existing PPMs or ICDs who underwent CRT upgrades to investigate the appropriate stage for CRT implantation in these patients and to assess the validity of treating both PPM and ICD recipients under the same recommendation level in the current guidelines. Materials and Methods: A total of 151 participants underwent analysis in this study, comprising 93 upgrades to cardiac resynchronisation therapy with pacemaker (CRT-P) and 58 upgrades to cardiac resynchronisation therapy with defibrillator (CRT-D) across three centres in the UK. The aim of the study was to investigate the safety and efficacy of upgrading to CRT from an existing conventional pacemaker or an ICD in the context of high-burden RV pacing. The analysis was conducted separately for each group, assessing changes in echocardiographic parameters, functional New York Heart Association (NYHA) class, and procedure-related complications. Results: The PPM group had a higher percentage RVP burden compared to the ICD group. Post-upgrade, NYHA functional class and EF and LV volumes improved in both groups; however, the response to an upgrade from a pacemaker was greater compared to an upgrade from an ICD. Post-procedural complication risks were similar across the two subgroups but significantly higher compared to de novo implantation. Conclusions: Within the CRT-P subgroup, participants exhibited better responses than their CRT-D counterparts, evident both in echocardiographic improvements and clinical outcomes. Furthermore, patients with non-ischemic cardiomyopathy (NICM) were better responders than those with ischaemic cardiomyopathy. These findings suggest that international guidelines should consider approaching each subgroup separately in the future.
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Affiliation(s)
- Arsalan Farhangee
- Department of Cardiology, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK;
- Department of Cardiology, Plymouth NHS Trust Foundation, Derriford Hospital, Plymouth PL6 8DH, UK; (B.J.S.); (R.M.)
- Department of Cardiology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincolnshire LN2 5QY, UK; (D.R.M.); (K.G.)
- Department of Cardiology, Oxford University Hospital, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.); (I.M.)
| | - Mark J. Davies
- Department of Cardiology, Milton Keynes University Hospital, Milton Keynes MK6 5LD, UK;
- Department of Cardiology, Oxford University Hospital, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Mihai Mesina
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.); (I.M.)
| | - David Roger Morgan
- Department of Cardiology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincolnshire LN2 5QY, UK; (D.R.M.); (K.G.)
| | - Benjamin J. Sieniewicz
- Department of Cardiology, Plymouth NHS Trust Foundation, Derriford Hospital, Plymouth PL6 8DH, UK; (B.J.S.); (R.M.)
| | - Robyn Meyrick
- Department of Cardiology, Plymouth NHS Trust Foundation, Derriford Hospital, Plymouth PL6 8DH, UK; (B.J.S.); (R.M.)
| | - Katie Gaughan
- Department of Cardiology, United Lincolnshire NHS Trust, Lincoln County Hospital, Lincolnshire LN2 5QY, UK; (D.R.M.); (K.G.)
| | - Ion Mîndrilă
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.); (I.M.)
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Yuecel G, Stoesslein K, Gaasch L, Kodeih A, Oeztuerk ON, Hetjens S, Yazdani B, Pfleger S, Liebe V, Rudic B, Behnes M, Langer H, Duerschmied D, Akin I, Kuschyk J. Long-term outcomes from upgrade to cardiac resynchronisation therapy in ischaemic versus non-ischaemic heart disease. Acta Cardiol 2024; 79:327-337. [PMID: 37961770 DOI: 10.1080/00015385.2023.2277624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Cardiac resynchronisation therapy (CRT) can be necessary in patients with chronic heart failure, who have already been provided with transvenous cardiac implantable electrical devices. Upgrade procedures revealed controversial results, while long-term outcomes regarding underlying Ischaemic- (ICM) or Non-Ischaemic heart disease (NICM) have yet to be described. METHODS The Mannheim Cardiac Resynchronisation Therapy Registry (MARACANA) was designed as a retrospective observational single-centre registry, including all CRT implantations from 2013-2021 (n = 459). CRT upgrades (n = 136) were retrospectively grouped to either ICM (n = 84) or NICM (n = 52) and compared for New York Heart Association classification (NYHA), paced QRS-width, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and other heart failure modification aspects in the long-term (59.3 ± 5 months). RESULTS Baseline-characteristics including paced QRS-width, upgrade indications or NYHA-classification were comparable for both groups (group comparison p>.05). The CRT upgrade improved NYHA (ICM: 2.98 ± 0.4 to 2.29 ± 0.7, NICM: 2.94 ± 0.5 to 2.08 ± 0.5) and the LVEF (ICM: 27.2 ± 6.6 to 38.25 ± 8.8, NICM: 30.2 ± 9.4 to 38.7 ± 13.8%) after five years, irrespective of underlying heart disease (each group p < .05, group comparison p>.05). Only ICM revealed significant improvements in TAPSE (15.9 ± 4.1 to 18.9 ± 4.1 mm) and narrowing of the paced QRS-width (185.4 ± 29 to 147.2 ± 16.3 ms) after five years (each p < .05). CONCLUSIONS Upgrade to CRT might improve heart failure symptoms and left-ventricular systolic function in the long-term, irrespective of underlying ischaemic or non-ischaemic heart disease.
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Affiliation(s)
- Goekhan Yuecel
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Karolina Stoesslein
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Leo Gaasch
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Abbass Kodeih
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Oezge Nur Oeztuerk
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim
| | - Babak Yazdani
- Fifth Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Stefan Pfleger
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Volker Liebe
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Boris Rudic
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Harald Langer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Juergen Kuschyk
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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3
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Zandi Z, Eslami M, Kamali F, Teimouri-Jervekani Z, Taherpour M, Mollazadeh R, Haghjoo M, Fazelifar AF, Alizadeh A, Madadi S, Hosseini Selki Sar S, Emkanjoo Z. Comparison of de novo implantation vs. upgrade cardiac resynchronisation therapy: a multicentre experience. Acta Cardiol 2024; 79:338-343. [PMID: 38032242 DOI: 10.1080/00015385.2023.2285539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The clinical safety and consequences of upgrade procedures compared with de novo cardiac resynchronisation therapy (CRT) implantation in heart failure remain unclear. The present study aimed to assess clinical and procedural consequences of patients undergoing CRT upgrade as compared to de novo CRT implantations. METHODS In this prospective cohort study, two subgroups were considered as the study population as (1) de novo group that CRT was considered on optimised medical treatment with heart failure of NYHA functional class from II to IV, left ventricular ejection fraction (LVEF) of ≤35%, and QRS width of >130 ms and (2) upgrade group including the patients with previously implantable cardioverter defibrillator (ICD) with the indications for upgrading to CRT. The two groups were compared regarding the changes in clinical outcome and echocardiography parameters. RESULTS The procedure was successful in 95.9% of patients who underwent CRT upgrade and 100% of those who underwent de novo CRT implantation. It showed a significant improvement in LVEF, severity of mitral regurgitation and NYHA functional classification, without any difference between the two study groups. Overall procedural related complications were reported in 10.8% and 3.8% (p = .093) and cardiac death in 5.4% and 2.5% (p = .360), respectively, with no overall difference in postoperative outcome between the two groups. CONCLUSIONS Upgrading to CRT is a safe and effective procedure regarding improvement of functional class, left ventricular function status and post-procedural outcome.
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Affiliation(s)
- Zahra Zandi
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Eslami
- Cardiology Department, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Kamali
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Teimouri-Jervekani
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Taherpour
- Department of Cardiac Electrophysiology, Razavi Hospital, Imam Reza International University, Mashhad, Iran
| | - Reza Mollazadeh
- Cardiology Department, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Farjam Fazelifar
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfath Alizadeh
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Madadi
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sajjad Hosseini Selki Sar
- Cardiology Department, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Emkanjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Schwertner WR, Tokodi M, Veres B, Behon A, Merkel ED, Masszi R, Kuthi L, Szijártó Á, Kovács A, Osztheimer I, Zima E, Gellér L, Vámos M, Sághy L, Merkely B, Kosztin A, Becker D. Phenogrouping and risk stratification of patients undergoing cardiac resynchronization therapy upgrade using topological data analysis. Sci Rep 2023; 13:20594. [PMID: 37996448 PMCID: PMC10667223 DOI: 10.1038/s41598-023-47092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Choosing the optimal device during cardiac resynchronization therapy (CRT) upgrade can be challenging. Therefore, we sought to provide a solution for identifying patients in whom upgrading to a CRT-defibrillator (CRT-D) is associated with better long-term survival than upgrading to a CRT-pacemaker (CRT-P). To this end, we first applied topological data analysis to create a patient similarity network using 16 clinical features of 326 patients without prior ventricular arrhythmias who underwent CRT upgrade. Then, in the generated circular network, we delineated three phenogroups exhibiting significant differences in clinical characteristics and risk of all-cause mortality. Importantly, only in the high-risk phenogroup was upgrading to a CRT-D associated with better survival than upgrading to a CRT-P (hazard ratio: 0.454 (0.228-0.907), p = 0.025). Finally, we assigned each patient to one of the three phenogroups based on their location in the network and used this labeled data to train multi-class classifiers to enable the risk stratification of new patients. During internal validation, an ensemble of 5 multi-layer perceptrons exhibited the best performance with a balanced accuracy of 0.898 (0.854-0.942) and a micro-averaged area under the receiver operating characteristic curve of 0.983 (0.980-0.986). To allow further validation, we made the proposed model publicly available ( https://github.com/tokmarton/crt-upgrade-risk-stratification ).
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Affiliation(s)
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Boglárka Veres
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Anett Behon
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Eperke Dóra Merkel
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Richárd Masszi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Luca Kuthi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Ádám Szijártó
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Máté Vámos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - László Sághy
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary.
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
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5
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Merkely B, Hatala R, Wranicz JK, Duray G, Földesi C, Som Z, Németh M, Goscinska-Bis K, Gellér L, Zima E, Osztheimer I, Molnár L, Karády J, Hindricks G, Goldenberg I, Klein H, Szigeti M, Solomon SD, Kutyifa V, Kovács A, Kosztin A. Upgrade of right ventricular pacing to cardiac resynchronization therapy in heart failure: a randomized trial. Eur Heart J 2023; 44:4259-4269. [PMID: 37632437 PMCID: PMC10590127 DOI: 10.1093/eurheartj/ehad591] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND AND AIMS De novo implanted cardiac resynchronization therapy with defibrillator (CRT-D) reduces the risk of morbidity and mortality in patients with left bundle branch block, heart failure and reduced ejection fraction (HFrEF). However, among HFrEF patients with right ventricular pacing (RVP), the efficacy of CRT-D upgrade is uncertain. METHODS In this multicentre, randomized, controlled trial, 360 symptomatic (New York Heart Association Classes II-IVa) HFrEF patients with a pacemaker or implantable cardioverter defibrillator (ICD), high RVP burden ≥ 20%, and a wide paced QRS complex duration ≥ 150 ms were randomly assigned to receive CRT-D upgrade (n = 215) or ICD (n = 145) in a 3:2 ratio. The primary outcome was the composite of all-cause mortality, heart failure hospitalization, or <15% reduction of left ventricular end-systolic volume assessed at 12 months. Secondary outcomes included all-cause mortality or heart failure hospitalization. RESULTS Over a median follow-up of 12.4 months, the primary outcome occurred in 58/179 (32.4%) in the CRT-D arm vs. 101/128 (78.9%) in the ICD arm (odds ratio 0.11; 95% confidence interval 0.06-0.19; P < .001). All-cause mortality or heart failure hospitalization occurred in 22/215 (10%) in the CRT-D arm vs. 46/145 (32%) in the ICD arm (hazard ratio 0.27; 95% confidence interval 0.16-0.47; P < .001). The incidence of procedure- or device-related complications was similar between the two arms [CRT-D group 25/211 (12.3%) vs. ICD group 11/142 (7.8%)]. CONCLUSIONS In pacemaker or ICD patients with significant RVP burden and reduced ejection fraction, upgrade to CRT-D compared with ICD therapy reduced the combined risk of all-cause mortality, heart failure hospitalization, or absence of reverse remodelling.
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Affiliation(s)
- Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Robert Hatala
- Department of Cardiology and Angiology, National Institute of Cardiovascular Diseases and Slovak Medical University, Bratislava, Slovakia
| | - Jerzy K Wranicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Gábor Duray
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, Budapest, Hungary
| | - Csaba Földesi
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Zoltán Som
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Marianna Németh
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
- Heart Institute, University of Pécs, Pécs, Hungary
| | - Kinga Goscinska-Bis
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Júlia Karády
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerhard Hindricks
- Department of Cardiology and Electrophysiology, German Heart Center of the Charite Berlin, Berlin, Germany
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Helmut Klein
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Mátyás Szigeti
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
- Imperial Clinical Trials Unit, Imperial College London, London, UK
- Physiological Controls Research Center, Budapest, Hungary
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valentina Kutyifa
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
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Maass AH, Daniëls F, Roseboom E, Vernooy K, Rienstra M. Special Issue: Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy and Conduction System Pacing. J Clin Med 2023; 12:jcm12103453. [PMID: 37240559 DOI: 10.3390/jcm12103453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiac Resynchronization Therapy (CRT) is an established technique to improve morbidity and mortality in selected heart failure patients [...].
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Affiliation(s)
- Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Fenna Daniëls
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
- Department of Cardiology, Isala Hospital, 8000 GK Zwolle, The Netherlands
| | - Eva Roseboom
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
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7
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Łoboda D, Wilczek J, Simionescu K, Biernat J, Jadczyk T, Wojakowski W, Gołba KS. Severe sleep apnea as a predictor of failure to respond to cardiac resynchronization therapy. Heart Lung 2023; 59:102-108. [PMID: 36801544 DOI: 10.1016/j.hrtlng.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The response to cardiac resynchronization therapy (CRT) is suboptimal in one-third of patients. OBJECTIVES The study aimed to evaluate the impact of sleep-disordered breathing (SDB) on the CRT-induced left ventricular (LV) reverse remodeling and response for CRT in patients with ischemic congestive heart failure (CHF). METHODS A total of 37 patients aged 65.43 years (SD 6.05), seven of whom were females, were treated with CRT according to class I European Society of Cardiology recommendations. Clinical evaluation, polysomnography, and contrast echocardiography were performed twice during the six-month follow-up (6M-FU) to assess the effect of CRT. RESULTS In 33 patients (89.1%), sleep-disordered breathing (SDB), predominantly central sleep apnea (70.3%) was observed. This include nine patients (24.3%) with an apnea-hypopnea index (AHI) of >30 events/hour. During the 6M-FU, 16 patients (47.1%) responded to CRT by reducing LV end-systolic volume index (LVESVi) by ≥15%. We stated a directly proportional linear relationship between AHI value and LV volume: LVESVi p = 0.004, and LV end-diastolic volume index p = 0.006. CONCLUSIONS Pre-existing severe SDB can impair the LV volumetric response to CRT even in an optimally selected group with class I indications for resynchronization, which may have an impact on long-term prognosis.
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Affiliation(s)
- Danuta Łoboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland.
| | - Karolina Simionescu
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland
| | - Tomasz Jadczyk
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland
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Merkely B, Gellér L, Zima E, Osztheimer I, Molnár L, Földesi C, Duray G, Wranicz JK, Németh M, Goscinska‐Bis K, Hatala R, Sághy L, Veres B, Schwertner WR, Fábián A, Fodor E, Goldenberg I, Kutyifa V, Kovács A, Kosztin A. Baseline clinical characteristics of heart failure patients with reduced ejection fraction enrolled in the BUDAPEST-CRT Upgrade trial. Eur J Heart Fail 2022; 24:1652-1661. [PMID: 35791276 PMCID: PMC9796950 DOI: 10.1002/ejhf.2609] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/23/2022] [Accepted: 07/02/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS The BUDAPEST-CRT Upgrade study is the first prospective, randomized, multicentre clinical trial investigating the outcomes after cardiac resynchronization therapy (CRT) upgrade in heart failure (HF) patients with intermittent or permanent right ventricular (RV) pacing with wide paced QRS. This report describes the baseline clinical characteristics of the enrolled patients and compares them to cohorts from previous milestone CRT studies. METHODS AND RESULTS This international multicentre randomized controlled trial investigates 360 patients having a pacemaker (PM) or implantable cardioverter defibrillator (ICD) device for at least 6 months prior to enrolment, reduced left ventricular ejection fraction (LVEF ≤35%), HF symptoms (New York Heart Association [NYHA] functional class II-IVa), wide paced QRS (>150 ms), and ≥20% of RV pacing burden without having a native left bundle branch block. At enrolment, the mean age of the patients was 73 ± 8 years; 89% were male, 97% were in NYHA class II/III functional class, and 56% had atrial fibrillation. Enrolled patients predominantly had conventional PM devices, with a mean RV pacing burden of 86%. Thus, this is a patient cohort with advanced HF, low baseline LVEF (25 ± 7%), high N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (2231 pg/ml [25th-75th percentile 1254-4309 pg/ml]), and frequent HF hospitalizations during the preceding 12 months (50%). CONCLUSION When compared with prior CRT trial cohorts, the BUDAPEST-CRT Upgrade study includes older patients with a strong male predominance and a high burden of atrial fibrillation and other comorbidities. Moreover, this cohort represents an advanced HF population with low LVEF, high NT-proBNP, and frequent previous HF events. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02270840.
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Affiliation(s)
- Béla Merkely
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | - László Gellér
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | - Endre Zima
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | | | - Levente Molnár
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | - Csaba Földesi
- Gottsegen National Cardiovascular CenterBudapestHungary
| | - Gábor Duray
- Department of CardiologyHungarian Defence Forces Medical CentreBudapestHungary
| | - Jerzy K. Wranicz
- Department of ElectrocardiologyMedical University of LodzLodzPoland
| | - Marianna Németh
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | - Kinga Goscinska‐Bis
- Department of Electrocardiology and Heart FailureMedical University of SilesiaKatowicePoland
| | - Robert Hatala
- Department of Cardiology and AngiologyNational Institute of Cardiovascular Diseases and Slovak Medical UniversityBratislavaSlovakia
| | - László Sághy
- Cardiac Electrophysiology Division, Department of Internal MedicineUniversity of SzegedSzegedHungary
| | - Boglárka Veres
- Semmelweis University, Heart and Vascular CenterBudapestHungary
| | | | | | | | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of RochesterRochesterNYUSA
| | - Valentina Kutyifa
- Semmelweis University, Heart and Vascular CenterBudapestHungary,Clinical Cardiovascular Research CenterUniversity of RochesterRochesterNYUSA
| | - Attila Kovács
- Semmelweis University, Heart and Vascular CenterBudapestHungary
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Pintér A, Behon A, Veres B, Merkel ED, Schwertner WR, Kuthi LK, Masszi R, Lakatos BK, Kovács A, Becker D, Merkely B, Kosztin A. The Prognostic Value of Anemia in Patients with Preserved, Mildly Reduced and Recovered Ejection Fraction. Diagnostics (Basel) 2022; 12:517. [PMID: 35204607 PMCID: PMC8871183 DOI: 10.3390/diagnostics12020517] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/02/2022] Open
Abstract
Data on the relevance of anemia in heart failure (HF) patients with an ejection fraction (EF) > 40% by subgroup-preserved (HFpEF), mildly reduced (HFmrEF) and the newly defined recovered EF (HFrecEF)-are scarce. Patients with HF symptoms, elevated NT-proBNP, EF ≥ 40% and structural abnormalities were registered in the HFpEF-HFmrEF database. We described the outcome of our HFpEF-HFmrEF cohort by the presence of anemia. Additionally, HFrecEF patients were also selected from HFrEF patients who underwent resynchronization and, as responders, reached 40% EF. Using propensity score matching (PSM), 75 pairs from the HFpEF-HFmrEF and HFrecEF groups were matched by their clinical features. After PMS, we compared the survival of the HFpEF-HFmrEF and HFrecEF groups. Log-rank, uni-and multivariate regression analyses were performed. From 375 HFpEF-HFmrEF patients, 42 (11%) died during the median follow-up time of 1.4 years. Anemia (HR 2.77; 95%CI 1.47-5.23; p < 0.01) was one of the strongest mortality predictors, which was also confirmed by the multivariate analysis (aHR 2.33; 95%CI 1.21-4.52; p = 0.01). Through PSM, the outcomes for HFpEF-HFmrEF and HFrecEF patients with anemia were poor, exhibiting no significant difference. In HFpEF-HFmrEF, anemia was an independent mortality predictor. Its presence multiplied the mortality risk in those with EF ≥ 40%, regardless of HF etiology.
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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12
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Brandão M, Almeida JG, Fonseca P, Monteiro J, Santos E, Rosas F, Nogueira Ribeiro J, Oliveira M, Gonçalves H, Primo J, Fontes-Carvalho R. Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score-matched analysis. Heart Rhythm O2 2022; 2:671-679. [PMID: 34988515 PMCID: PMC8710617 DOI: 10.1016/j.hroo.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Upgrade to cardiac resynchronization therapy (CRT) is common in Europe, despite little and conflicting evidence. Objective To compare long-term clinical outcomes in a cohort of patients receiving de novo or upgrade to CRT. Methods Single-center retrospective study of 295 consecutive patients submitted to CRT implantation between 2007 and 2018. Upgraded and de novo patients complying with a dedicated follow-up protocol were compared in terms of clinical (NYHA class improvement without major adverse cardiac events [MACE] in the first year of follow-up) and echocardiographic (left ventricle end-systolic volume reduction of >15% during the first year) response. Results No differences in the rate of clinical (59.3% vs 62.6%, P = .765) or echocardiographic response (72.2% vs 71.9%, P = .970) between groups were observed. Device-related complications were also comparable between groups (8.9% vs 8.4%, P = .892). Occurrence of MACE and all-cause mortality were analyzed over a median follow-up of 3 (interquartile range 1–6) years: MACE occurred less frequently in the de novo group (hazard ratio [HR]: 0.55, 95% confidence interval [CI]: 0.34–0.90, P = .018), but all-cause mortality was similar among groups (HR: 0.87, 95% CI: 0.46–1.64, P = .684). Propensity score–matching analysis was performed to adjust for possible confounder variables. In the propensity-matched samples, all-cause mortality (HR: 1.26, 95% CI: 0.56–2.77, P = .557) and MACE (HR: 0.84, 95% CI: 0.46–1.54, P = .574) were comparable between upgrade and de novo patients. Conclusion Survival after upgrade to resynchronization therapy was comparable to de novo implants. Additionally, clinical and echocardiographic response to CRT in upgraded patients were similar to de novo patients.
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Affiliation(s)
- Mariana Brandão
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - João Gonçalves Almeida
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Paulo Fonseca
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Joel Monteiro
- Cardiology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Elisabeth Santos
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Filipa Rosas
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - José Nogueira Ribeiro
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Marco Oliveira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Helena Gonçalves
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - João Primo
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Vaidya VR, Asirvatham R, Kowlgi GN, Dai MY, Cochuyt JJ, Hodge DO, Deshmukh AJ, Cha YM. Trends in Cardiovascular Implantable Electronic Device Insertion Between 1988 and 2018 in Olmsted County. JACC Clin Electrophysiol 2022; 8:88-100. [PMID: 34454890 PMCID: PMC9339254 DOI: 10.1016/j.jacep.2021.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study sought to describe trends in cardiovascular implantable electronic device (CIED) insertion over the past 3 decades in Olmsted County. BACKGROUND Trends in CIED insertion in the United States have not been extensively studied. METHODS The Rochester Epidemiology Project is a medical records linkage system comprising the records of all residents of Olmsted County from 1966 to the present. CIED insertion between 1988 and 2018 was determined using International Classification of Diseases-Ninth Revision, International Classification of Diseases-10th Revision, and Current Procedural Terminology codes. Age- and sex-adjusted incidence rates, adjusted to the 2010 US White population, were calculated. Trends in incidence over time, across age groups, and between sex are estimated using Poisson regression models. RESULTS The age- and sex-adjusted incidence of device implants for the study period were as follows: overall CIED: 82.4 (95% CI: 79.2-85.6); permanent pacemaker (PPM): 62.9 (95% CI: 60.0-65.7); implantable cardioverter-defibrillator (ICD): 14.0 (95% CI: 12.6-15.3); and cardiac resynchronization therapy (CRT): 5.6 (95% CI: 4.7-6.4) per 100,000 per year. The overall incidence of CIED insertion increased between 1988 to 1993 and 2000 to 2005 and then decreased between 2000 to 2005 and 2012 to 218 (P < 0.0001). PPM and ICD insertion incidence followed these trends, whereas the incidence of CRT insertion increased between 2000 to 2005 and 2012 to 2018. CIED insertion incidence increased with age (P < 0.0001). CIED insertion incidence was greater in men (116.3 vs 57.3 per 100,000 per year in men vs women; P < 0.0001). The overall survival of CRT recipients improved (P = 0.0044). CONCLUSIONS The incidence values for PPM and ICD implants are decreasing, while the incidence of CRT implants is increasing. CIEDs are increasingly inserted in the elderly, men, and patients with higher comorbidities.
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Affiliation(s)
- Vaibhav R. Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Roshini Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Gurukripa N. Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ming-Yan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA,Cardiovascular Research Institute and Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jordan J. Cochuyt
- Department of Quantitative Heath Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | - David O. Hodge
- Department of Quantitative Heath Sciences, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Yong Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Stassen J, Scherrenberg M, Dilling-Boer D, Vijgen J, Koopman P, Schurmans J, Herbots L, Verwerft J, Schroyens M, Timmermans P. Comparison of de novo versus upgrade cardiac resynchronisation therapy on clinical effect and long-term outcome. Acta Cardiol 2021; 76:993-1000. [PMID: 33432875 DOI: 10.1080/00015385.2020.1867387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The benefit of de novo cardiac resynchronisation therapy (CRT) implantation in selected patients with heart failure is well known. The number of upgrade procedures is increasing but data on clinical response and outcome are less well documented as compared to de novo implantation. OBJECTIVES To investigate the efficacy and outcome of CRT upgrade procedures in patients with existing cardiac implantable electronic devices (CIEDs). METHODS Baseline characteristics, change in New York Heart Association (NYHA) functional class, echocardiographic parameters, life-threatening ventricular tachyarrhythmias, all-cause mortality and mode of death were evaluated in CRT patients with the comparison between de novo and upgrade CRT procedures. RESULTS About 410 patients (CRT upgrade/de novo CRT, n = 97/313) were followed for 63.5 ± 38.1 months. Upgrade patients were older (75.5 ± 8.1 vs 69.9 ± 10.7 years; p < 0.001), had more often an ischaemic cause of heart failure (58.8% vs 45.4%; p = 0.021), a higher NYHA functional class (p = 0.004) and a higher comorbidity burden. Improvement in left ventricular ejection fraction (LVEF) was higher in the de novo CRT group (8.4 ± 9.9 vs 11.0 ± 10.3%; p = 0.035). Clinical response was similar between both groups (60.5 vs 62.5%; p = 0.793), as was mortality at 1 year (8.2 vs 5.8%; p = 0.351) and at last follow-up (33.0 vs 28.8%; p = 0.447). The proportion of cardiovascular related deaths was similar between both groups (46.9% vs 38.9%; p = 0.531). CONCLUSIONS Patients with CRT upgrade procedures have similar symptomatic improvements, as well as 1 year and long-term outcome as compared to patients with de novo CRT implantation.
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Affiliation(s)
- Jan Stassen
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
| | - Martijn Scherrenberg
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Agoralaan, Belgium
| | | | - Johan Vijgen
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
| | | | | | | | - Jan Verwerft
- Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 857] [Impact Index Per Article: 285.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Jędrzejczyk-Patej E, Mazurek M, Kotalczyk A, Kowalska W, Konieczny-Kozielska A, Kozielski J, Podolecki T, Szulik M, Sokal A, Kowalski O, Kalarus Z, Średniawa B, Lenarczyk R. Upgrade from implantable cardioverter-defibrillator vs. de novo implantation of cardiac resynchronization therapy: long-term outcomes. Europace 2021; 23:113-122. [PMID: 33257952 DOI: 10.1093/europace/euaa339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/17/2020] [Indexed: 12/24/2022] Open
Abstract
AIMS To assess and compare long-term mortality and predictors thereof in de novo cardiac resynchronization therapy defibrillators (CRT-D) vs. upgrade from an implantable cardioverter-defibrillator (ICD) to CRT-D. METHODS AND RESULTS Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in a tertiary care, university hospital, in a densely inhabited, urban region of Poland [480 subjects (84.3%) with CRT-D de novo implantation; 115 patients (15.7%) upgraded from ICD to CRT-D]. In a median observation of 1692 days (range 457-3067), all-cause mortality for de novo CRT-D vs. CRT-D upgrade was 35.5% vs. 43.5%, respectively (P = 0.045). On multivariable regression analysis including all CRT recipients, the previously implanted ICD was an independent predictor for death [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.10-2.29, P = 0.02]. For those, who were upgraded from ICD to CRT-D, the independent predictors for all-cause death were as follows: creatinine level (HR 1.01, 95% CI 1.00-1.02, P = 0.01), left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02-1.11, P = 0.002), New York Heart Association (NYHA) IV class at baseline (HR 2.36, 95% CI 1.00-5.53, P = 0.049) and cardiac device-related infective endocarditis during follow-up (HR 2.42, 95% CI 1.02-5.75, P = 0.046). A new CRT scale (Creatinine ≥150 μmol/L; Remodelling, left ventricular end-systolic ≥59 mm; Threshold for NYHA, NYHA = IV) showed high prediction for mortality in CRT-D upgrades (AUC 0.70, 95% CI 0.59-0.80, P = 0.0007). CONCLUSION All-cause mortality in patients upgraded from ICD is significantly higher compared with de novo CRT-D implantations and reaches almost 45% within 4.5 years. A new CRT scale (Creatinine; Remodelling; Threshold for NYHA) has been proposed to help survival prediction following CRT upgrade.
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Affiliation(s)
- Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Agnieszka Kotalczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Wiktoria Kowalska
- Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Konieczny-Kozielska
- Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jonasz Kozielski
- Students Scientific Society, Department of Cardiology, Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Adam Sokal
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Oskar Kowalski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Zbigniew Kalarus
- Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Beata Średniawa
- Division of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Radosław Lenarczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
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Schwertner WR, Behon A, Merkel ED, Tokodi M, Kovács A, Zima E, Osztheimer I, Molnár L, Király Á, Papp R, Gellér L, Kuthi L, Veres B, Kosztin A, Merkely B. Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience. Europace 2021; 23:1310-1318. [PMID: 34037220 PMCID: PMC8350864 DOI: 10.1093/europace/euab059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Patients with a pacemaker or implantable cardioverter-defibrillator are often considered for cardiac resynchronization therapy (CRT). However, limited comprehensive data are available regarding their long-term outcomes. METHODS AND RESULTS Our retrospective registry included 2524 patients [1977 (78%) de novo, 547 (22%) upgrade patients] with mild to severe symptoms, left ventricular ejection fraction ≤35%, and QRS ≥ 130ms. The primary outcome was the composite of all-cause mortality, heart transplantation (HTX), or left ventricular assist device (LVAD) implantation; secondary endpoints were death from any cause and post-procedural complications. In our cohort, upgrade patients were older [71 (65-77) vs. 67 (59-73) years; P < 0.001], were less frequently females (20% vs. 27%; P = 0.002) and had more comorbidities than de novo patients. During the median follow-up time of 3.7 years, 1091 (55%) de novo and 342 (63%) upgrade patients reached the primary endpoint. In univariable analysis, upgrade patients exhibited a higher risk of mortality/HTX/LVAD than the de novo group [hazard ratio (HR): 1.41; 95% confidence interval (CI): 1.23-1.61; P < 0.001]. However, this difference disappeared after adjusting for covariates (adjusted HR: 1.12; 95% CI: 0.86-1.48; P = 0.402), or propensity score matching (propensity score-matched HR: 1.10; 95% CI: 0.95-1.29; P = 0.215). From device-related complications, lead dysfunction (3.1% vs. 1%; P < 0.001) and pocket infections (3.7% vs. 1.8%; P = 0.014) were more frequent in the upgrade group compared to de novo patients. CONCLUSION In our retrospective analysis, upgrade patients had a higher risk of all-cause mortality than de novo patients, which might be attributable to their more significant comorbidity burden. The occurrence of lead dysfunction and pocket infections was more frequent in the upgrade group.
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Affiliation(s)
| | - Anett Behon
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Eperke Dóra Merkel
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - István Osztheimer
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Levente Molnár
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Ákos Király
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Roland Papp
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - László Gellér
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Luca Kuthi
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Boglárka Veres
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Annamária Kosztin
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Városmajor 68, H-1122 Budapest, Hungary
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Tan L, Ganesananthan S, Huzaien H, Elsayed H, Shah N, Shah P, Yousef Z. Upgrading to cardiac resynchronisation therapy: Concordance of real-world experience with clinical guidelines. IJC HEART & VASCULATURE 2021; 33:100746. [PMID: 33748400 PMCID: PMC7957085 DOI: 10.1016/j.ijcha.2021.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/04/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
Objective Revision to cardiac resynchronisation therapy (CRT) in patients with existing pacemakers with worsening heart failure (HF) can improve symptoms and cardiac function. We identify factors that predict improvement in left ventricular ejection fraction (LVEF) within a year of CRT revision. Methods We performed a retrospective study of 146 consecutive patients (16% female, mean age 73 ± 11 years, mean LVEF 27 ± 8%) undergoing revision to CRT (January 2012 to May 2018) in a single tertiary centre. LVEF was measured pre-revision and 3, 6 and 12 months post-upgrade. Results At 6 months, 68% of patients demonstrated improvement in LVEF (mean ΔLVEF + 6.7% ± 9.6). Compared to patients in atrial fibrillation (AF), patients with sinus rhythm had a greater improvement in LVEF at 6 months (sinus 8.4 ± 10.3% vs. AF 4.2 ± 8.0%, p = 0.02). Compared to ischaemic cardiomyopathy (ICM), patients with non-ischaemic cardiomyopathy (NICM) had a greater improvement in LVEF at 6 months (NICM 8.4 ± 9.8% vs ICM 4.8 ± 9.2%, p = 0.05). Patients with RV pacing ≥40% at baseline had a greater improvement in LVEF at 6 months (≥40% RV pacing 9.3 ± 10.2 vs. < 40% RV pacing 4.0 ± 7.4%, p = 0.01). All improvements were sustained over 12 months post-revision. There was no significant difference between genders, years between initial implant and revision, or previous device type. Conclusions Our real-world experience supports current guidelines on CRT revision. NICM, ≥40% RV pacing and sinus rhythm are the main predictors of improvement in LVEF in patients who underwent CRT revision.
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Affiliation(s)
- Laura Tan
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | | | - Hani Huzaien
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Hossam Elsayed
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Nisar Shah
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Parin Shah
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
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21
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Rath B, Willy K, Wolfes J, Ellermann C, Reinke F, Köbe J, Eckardt L, Frommeyer G. Predictors of response to cardiac resynchronization therapy in patients with chronic right ventricular pacing. Clin Res Cardiol 2020; 110:877-883. [PMID: 33320290 PMCID: PMC8166655 DOI: 10.1007/s00392-020-01785-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Abstract
Background The benefits of de novo cardiac resynchronization therapy (CRT) in patients with QRS-prolongation and impaired left-ventricular function (LVEF) are well established. Current guidelines also recommend CRT-upgrade in patients requiring permanent or frequent right ventricular pacing (RVP) with symptomatic heart failure and reduced LVEF. Whereas several predictors of response to de novo CRT-implantation such as female gender, QRS-duration, non-ischemic cardiomyopathy (NICM) are known due to large prospective trials, similar factors regarding CRT-upgrade are currently lacking. Methods and results We examine 114 patients 3–6 months after CRT-upgrade due to frequent RVP (> 50%) and symptomatic heart failure. Response to CRT was evaluated by improvement in NYHA class referring to the Minnesota Living With Heart Failure Questionnaire. Only cardiomyopathy type and use of Angiotensin-converting-enzyme (ACE) inhibitor had an impact on response to CRT-upgrade in a linear regression model. Patients with NICM presented a greater responder rate than patients with ischemic cardiomyopathy (ICM) (80.4 vs. 60.3%, p < 0.05). Other traditional response predictors in de novo CRT recipients (e.g. QRS-width, female gender) showed no effect on CRT-response in this cohort. Conclusion Only underlying heart disease (NICM vs. ICM) and the use of ACE inhibitor were significant predictors of response to CRT-upgrade. In contrast to de novo CRT-recipients, where pre-implant QRS-duration is a key predictor, QRS-duration during RV-pacing has no significant impact on CRT-response in this cohort. Graphic abstract ![]()
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Affiliation(s)
- Benjamin Rath
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Kevin Willy
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julian Wolfes
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Comparative Analysis of Procedural Outcomes and Complications Between De Novo and Upgraded Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2020; 7:62-72. [PMID: 33478714 DOI: 10.1016/j.jacep.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study compared rates of procedural success and complications between de novo cardiac resynchronization therapy (CRT) implantation versus upgrade, including characterization of technical challenges. BACKGROUND CRT upgrade is common, but data are limited on the incidence of procedural success and complications as compared to de novo implantation. METHODS All patients who underwent a transvenous CRT procedure at a single institution between 2013 and 2018 were reviewed for procedure outcome, 90-day complications, reasons for unsuccessful left ventricular lead delivery, and the presence of venous occlusive disease (VOD) that required a modified implantation technique. RESULTS Among 1,496 patients, 947 (63%) underwent de novo implantation and 549 (37%) underwent device upgrade. Patients who received a device upgrade were older (70 ± 12 years vs. 68 ± 13 years; p < 0.01), with a male predominance (75% vs. 66%; p < 0.01) and greater prevalence of comorbidities. There was no difference in the rate of procedural success between de novo and upgrade CRT procedures (97% vs. 96%; p = 0.28) or 90-day complications (5.1% vs. 4.6%; p = 0.70). VOD was present in 23% of patients who received a device upgrade and was more common among patients with a dual-chamber versus a single-chamber device (26% vs. 9%; p < 0.001). Patients with and without VOD had a similar composite outcome of procedural failure or complication (8.0% vs. 7.8%; p = 1.0). CONCLUSIONS Rates of procedural success and complications were no different between de novo CRT implantations and upgrades. VOD frequently increased procedural complexity in upgrades, but alternative management strategies resulted in similar outcomes. Routine venography before CRT upgrade may aid in procedural planning and execution of these strategies.
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Comparison of left ventricular lead upgrade vs continued medical care among patients eligible for cardiac resynchronization therapy at the time of defibrillator generator replacement: Predictors of left ventricular lead upgrade and associations with long-term outcomes. Heart Rhythm 2020; 17:1878-1886. [PMID: 32497762 DOI: 10.1016/j.hrthm.2020.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/08/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Randomized trials evaluating cardiac resynchronization therapy (CRT) have excluded patients with a pre-existing implantable cardioverter-defibrillator (ICD). The association of CRT upgrade with clinical outcomes in patients with a pre-existing ICD is unclear. OBJECTIVE The purpose of this study was to examine a CRT-eligible population to evaluate clinical outcomes associated with CRT upgrade compared to patients who did not undergo CRT. METHODS Using the National Cardiovascular Data Registry (NCDR) ICD Registry between April 2010 and December 2014, we created a hierarchical logistic regression model to identify predictors of CRT upgrade in a CRT-eligible ICD population. In the subpopulation of patients with Medicare-linked claims data, differential outcomes were determined with censoring at 3 years. The primary endpoint of this study was all-cause mortality, with secondary endpoints of rates of hospitalization and procedural complications. RESULTS CRT upgrade was performed in 75.5% of CRT-eligible patients with pre-existing ICD (n = 15,803). Presence of left bundle branch block conduction was the strongest predictor of CRT upgrade (odds ratio [OR] 4.56; 95% confidence interval [CI] 4.08-5.11; P <.0001). In both unadjusted and adjusted analyses, CRT upgrade was associated with a reduction in mortality at 3 years (unadjusted hazard ratio [HR] 0.80; 95% CI 0.70-0.92; P = .001; adjusted HR 0.84; 95% CI 0.72-0.98; P = .02, respectively). Compared to patients with ICD generator replacement only, patients who underwent CRT upgrade experienced no different 3-year rates of hospitalization (adjusted HR 1.01; 95% CI 0.91-1.12; P = .81) or 1-year periprocedural complication rates (adjusted HR 1.07; 95% CI 0.79-1.45; P = .66). CONCLUSION In a national registry of CRT-eligible patients with pre-existing ICD, upgrade to CRT was associated with lower rates of mortality than continued medical management.
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Loboda D, Gibinski M, Zietek K, Wilczek J, Gardas R, Gladysz-Wanha S, Golba KS. Survival of patients with pacing-induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:471-478. [PMID: 32198771 DOI: 10.1111/pace.13906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/15/2020] [Accepted: 03/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Permanent right ventricular pacing (RVP) results in cardiac dyssynchrony that may lead to heart failure and may be an indication for the use of cardiac resynchronization therapy (CRT). The study aimed to evaluate predictors of outcomes in patients with pacing-induced cardiomyopathy (PICM) if upgraded to CRT. METHODS One hundred fifteen patients, 75.0 years old (IQR 67.0-80.0), were upgraded to CRT due to the decline in left ventricle ejection fraction (LVEF) caused by the long-term RVP. A retrospective analysis was performed using data from hospital and outpatient clinic records and survival data from the National Health System. RESULTS The prior percentage of RVP was 100.0% (IQR 97.0-100.0), with a QRS duration of 180.0 ms (IQR 160.0-200.0). LVEF at the time of the upgrade procedure was 27.0% (IQR 21.0-32.75). The mean follow-up was 980 ± 522 days. The primary endpoint, death from any cause, was met by 26 (22%) patients. Age > 82 years (HR 5.96; 95% CI 2.24-15.89; P = .0004) and pre-CRT implantation LVEF < 20% (HR 5.63; 95%CI 2.19-14.47; P = .0003), but neither the cardioverter-defibrillator (ICD) implantation (HR 1.00; 95%CI 0.45-2.22; P = 1.00), nor the presence of atrial fibrillation (HR 1.22; 95%CI 0.56-2.64; P = .62), were independently associated with all-cause mortality. CONCLUSION Advanced age and an extremely low LVEF, but neither the presence of atrial fibrillation nor implanting an additional high voltage lead, influence the all-cause mortality in patients after long-term RVP, when upgraded to CRT.
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Affiliation(s)
- Danuta Loboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Michal Gibinski
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Karolina Zietek
- Faculty of Medicine, Medical University of Silesia, Katowice, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Rafal Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Sylwia Gladysz-Wanha
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Golba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
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Rickard J, Gorodeski EZ, Patel D, Hussein A, Moennich LA, Cantillon D, Trulock K, Toro S, Niebauer M, Varma N, Wilkoff BL. Long term outcomes in patients with chronic right ventricular pacing upgraded to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2019; 30:1979-1983. [PMID: 31211474 DOI: 10.1111/jce.14038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/09/2019] [Accepted: 06/14/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In patients with chronic systolic heart failure and frequent right ventricular pacing (RVP), upgrade to cardiac resynchronization therapy (CRT) has become common practice despite a lack of randomized clinical trials. We aimed to evaluate long term outcomes in patients upgraded to CRT from chronic RVP compared with de novo CRT implants. METHODS AND RESULTS We reviewed medical charts on consecutive patients with a left ventricular ejection fraction (LVEF) ≤ 35% and a QRSd ≥ 120 ms undergoing CRT. Survival free of left ventricular assist device (LVAD) and a heart transplant was compared amongst patients on the basis of pre-CRT QRS morphology. Improvement in LVEF was also compared across groups. A total of 1260 patients met inclusion criteria of whom 233 were upgraded from chronic RVP. Over a mean follow up 6.5 ± 4.0 years there were 821 endpoints (27 LVAD, 30 heart transplants, and 764 deaths). In a multivariate Cox regression model, upgraded patients had worse outcomes (HR 1.3(1.1-1.7) P = .007) compared with those with native LBBB and similar outcomes to patients with non-LBBB(HR 0.96(0.76-1.21) P = .7). The survival curve for chronic RVP parallels native LBBB for approximately 2.5 years before dropping sharply. Patients with chronic RVP derive similar improvements in LVEF compared with those with LBBB and superior improvements compared with those with non-LBBB. CONCLUSIONS Despite achieving similar levels of LVEF improvement, patients with systolic heart failure with chronic RVP undergoing upgrade to CRT have inferior long term outcomes compared with patients with native LBBB. Long term outcomes with CRT in patients with chronic RVP, RBBB, and IVCD are similar.
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Affiliation(s)
- John Rickard
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Eiran Z Gorodeski
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Divyang Patel
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Ayman Hussein
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Laurie Anne Moennich
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Daniel Cantillon
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Kevin Trulock
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Saleem Toro
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Mark Niebauer
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Niraj Varma
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Bruce L Wilkoff
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
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Abstract
Right ventricular (RV) function has proven to be a prognostic factor in heart failure with reduced and preserved ejection fraction and in pulmonary hypertension. RV function is also a cornerstone in the management of novel clinical issues, such as mechanical circulatory support devices or grown-up congenital heart disease patients. Despite the notable amount of circumferentially oriented myofibers in the subepicardial layer of the RV myocardium, the non-longitudinal motion directions are often neglected in the everyday assessment of RV function by echocardiography. However, the complex RV contraction pattern incorporates different motion components along three anatomically relevant axes: longitudinal shortening with traction of the tricuspid annulus towards the apex, radial motion of free wall often referred as the "bellows effect", and anteroposterior shortening of the chamber by stretching the free wall over the septum. Advanced echocardiographic techniques, such as speckle-tracking and 3D echocardiography allow an in-depth characterization of RV mechanical pattern, providing better understanding of RV systolic and diastolic function. In our current review, we summarize the existing knowledge regarding RV mechanical adaptation to pressure- and/or volume-overloaded states and also other physiologic or pathologic conditions.
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MESH Headings
- Adaptation, Physiological/physiology
- Arrhythmogenic Right Ventricular Dysplasia/physiopathology
- Cardiac Surgical Procedures/adverse effects
- Cardiomegaly, Exercise-Induced/physiology
- Echocardiography, Three-Dimensional
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/physiopathology
- Heart Failure/complications
- Heart Failure/physiopathology
- Heart Ventricles/diagnostic imaging
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right/physiology
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Affiliation(s)
- Attila Kovács
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary.
| | - Bálint Lakatos
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Márton Tokodi
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
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Goette A, Auricchio A, Boriani G, Braunschweig F, Terradellas JB, Burri H, Camm AJ, Crijns H, Dagres N, Deharo JC, Dobrev D, Hatala R, Hindricks G, Hohnloser SH, Leclercq C, Lewalter T, Lip GYH, Merino JL, Mont L, Prinzen F, Proclemer A, Pürerfellner H, Savelieva I, Schilling R, Steffel J, van Gelder IC, Zeppenfeld K, Zupan I, Heidbüchel H, Boveda S, Defaye P, Brignole M, Chun J, Guerra Ramos JM, Fauchier L, Svendsen JH, Traykov VB, Heinzel FR. EHRA White Paper: knowledge gaps in arrhythmia management—status 2019. Europace 2019; 21:993-994. [DOI: 10.1093/europace/euz055] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Clinicians accept that there are many unknowns when we make diagnostic and therapeutic decisions. Acceptance of uncertainty is essential for the pursuit of the profession: bedside decisions must often be made on the basis of incomplete evidence. Over the years, physicians sometimes even do not realize anymore which the fundamental gaps in our knowledge are. As clinical scientists, however, we have to halt and consider what we do not know yet, and how we can move forward addressing those unknowns. The European Heart Rhythm Association (EHRA) believes that scanning the field of arrhythmia / cardiac electrophysiology to identify knowledge gaps which are not yet the subject of organized research, should be undertaken on a regular basis. Such a review (White Paper) should concentrate on research which is feasible, realistic, and clinically relevant, and should not deal with futuristic aspirations. It fits with the EHRA mission that these White Papers should be shared on a global basis in order to foster collaborative and needed research which will ultimately lead to better care for our patients. The present EHRA White Paper summarizes knowledge gaps in the management of atrial fibrillation, ventricular tachycardia/sudden death and heart failure.
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Affiliation(s)
- Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Cardiology and Intensive Care Medicine, Am Busdorf 2, Paderborn, Germany
- Working Group Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano (Ticino), Switzerland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - A John Camm
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | - Harry Crijns
- Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht UMC+, Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Dobromir Dobrev
- University Duisburg-Essen, Institute of Pharmacology, Essen, Germany
| | - Robert Hatala
- Department of Cardiology and Angiology, National Cardiovascular Institute, NUSCH, Bratislava, Slovak Republic
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt, Germany
| | | | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital for Internal Medicine Munich South, Munich, Germany
- Department of Cardiology, University of Bonn, Bonn, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jose Luis Merino
- Hospital Universitario La Paz, Arrhythmia and Robotic EP Unit, Madrid, Spain
| | - Lluis Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Frits Prinzen
- Department of Physiology, Maastricht University, Maastricht, Netherlands
| | | | - Helmut Pürerfellner
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Academic Teaching Hospital, Linz, Austria
| | - Irina Savelieva
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | | | - Jan Steffel
- University Heart Center Zurich, Zurich, Switzerland
| | - Isabelle C van Gelder
- Department Of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (Lumc), Leiden, Netherlands
| | - Igor Zupan
- Department Of Cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Hein Heidbüchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Pascal Defaye
- CHU Hôpital Albert Michalon, Unité de Rythmologie Service De Cardiologie, FR-38043 Grenoble Cedex 09, France
| | - Michele Brignole
- Department of Cardiology, Ospedali Del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna (GE), Italy
| | - Jongi Chun
- CCB, Cardiology Department, Med. Klinik Iii, Markuskrankenhaus, Wilhelm Epstein Str. 4, DE-60431 Frankfurt, Germany
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine, Tours, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Frank R Heinzel
- Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany
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Boriani G, Diemberger I. Cardiac resynchronization therapy in the real world: need to upgrade outcome research. Eur J Heart Fail 2018; 20:1469-1471. [DOI: 10.1002/ejhf.1288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences; University of Modena and Reggio Emilia, Policlinico of Modena; Modena Italy
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna, S. Orsola-Malpighi University Hospital; Bologna Italy
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Sidhu BS, Gould J, Sieniewicz BJ, Porter B, Rinaldi CA. Complications associated with cardiac resynchronization therapy upgrades versus de novo implantations. Expert Rev Cardiovasc Ther 2018; 16:607-615. [PMID: 29985076 DOI: 10.1080/14779072.2018.1498783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION A significant number of patients undergo upgrade to cardiac resynchronization therapy (CRT). These patients tend to differ from individuals undergoing de novo CRT implantations both in terms of their baseline demographics and the etiology underlying their heart failure. Areas covered: There are several factors that need to be considered when upgrading patients to CRT, such as, venous patency. Potentially, these conditions can cause issues which may result in procedures being more difficult than de novo implantations. This article discusses these issues and compares the rates of procedural-related complications for CRT upgrades and de novo implantations. It discusses the proportion of patients that are likely to respond to CRT with each intervention. Expert commentary: Understanding the relative risks of CRT upgrades versus de novo implantations is important to help operators select the correct initial device and counsel patients accordingly. Growing experience with image-guided implantations and endocardial pacing may prove to be particularly relevant to patients undergoing CRT upgrades.
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Affiliation(s)
- Baldeep S Sidhu
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
| | - Justin Gould
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
| | - Benjamin J Sieniewicz
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
| | - Bradley Porter
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
| | - Christopher A Rinaldi
- a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.,b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK
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30
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Linde CM, Normand C, Bogale N, Auricchio A, Sterlinski M, Marinskis G, Sticherling C, Bulava A, Pérez ÓC, Maass AH, Witte KK, Rekvava R, Abdelali S, Dickstein K. Upgrades from a previous device compared to de novo cardiac resynchronization therapy in the European Society of Cardiology CRT Survey II. Eur J Heart Fail 2018; 20:1457-1468. [PMID: 29806208 DOI: 10.1002/ejhf.1235] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To date, there are no data from randomized controlled studies on the benefit of cardiac resynchronization therapy (CRT) when implanted as an upgrade in patients with a previous device as compared to de novo CRT. In the CRT Survey II we compared the baseline data of patients upgraded to CRT (CRT-P/CRT-D) from a previous pacemaker (PM) or implantable cardioverter-defibrillator (ICD) to de novo CRT implantation. METHODS AND RESULTS In the European CRT Survey II, clinical practice data of patients undergoing CRT and/or ICD implantation across 42 European Society of Cardiology (ESC) countries were collected between October 2015 and December 2016. Out of a total of 11 088 patients, 2396 (23.2%) were upgraded from a previous PM or ICD and 7933 (76.8%) underwent de novo implantation. Compared to de novo implantations, upgraded patients were older, more often male, more frequently had ischaemic heart failure aetiology, atrial fibrillation, reduced renal function, worse heart failure symptoms, and higher N-terminal pro-B-type natriuretic peptide levels. Upgraded patients were more often PM-dependent and less frequently received CRT-D. Total peri-procedural, in-hospital complications and length of hospital stay were similar. Upgraded patients were less frequently treated with heart failure medication at discharge. CONCLUSION Despite a lack of evidenced-based data, close to one quarter of all CRT implantations across 42 ESC countries were upgrades from a previous PM or ICD. Despite older age and worse symptoms, the CRT implantation procedures in upgraded patients were equally frequently successful and complications similar to de novo implantations. These results call for more studies.
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Affiliation(s)
- Cecilia M Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Camilla Normand
- Department of Internal Medicine, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger, Norway
| | | | - Angelo Auricchio
- Clinical Electrophysiology Unit, Fondazione Cardiocentro Ticino, Lugano, Switzerland; and University Magdeburg, Germany
| | | | | | | | - Alan Bulava
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Óscar Cano Pérez
- Unidad de Arritmias, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Alexander H Maass
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Roin Rekvava
- Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | | | - Kenneth Dickstein
- Department of Internal Medicine, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger, Norway
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